Global Burden of Cardiovascular Diseases

In recent years, the dominance of chronic diseases as major contributors to total global mortality has emerged and has been previously described in detail elsewhere. By 2005, the total number of cardiovascular disease (CVD) deaths (mainly coronary heart disease, stroke, and rheumatic heart disease) had increased globally to 17.5 million from 14.4 million in 1990. Of these, 7.6 million were attributed to coronary heart disease and 5.7 million to stroke. More than 80 percent of the deaths occurred in low and middle income countries (WHO, 2009e).

Based on 2007 to 2010 data, 33% of US adults ≥ 20 years of age have hypertension. This represents ~ 78 million US adults with hypertension. The prevalence of hypertension is similar for men and women. African American adults have among the highest prevalence of hypertension (44%) in the world.

New online care for hypertension gets results

Jun 24, 2008 Viewed: 453

Web-based care and at-home blood pressure checks can help control hypertension without office visits, according to the “e-BP” (Electronic Blood Pressure) study of more than 700 Group Health patients published in the June 25 Journal of the American Medical Association.

“To our knowledge, this is the first large randomized controlled trial to use Web-based care and a patient-shared electronic medical record to improve treatment outcomes of a chronic disease,” said study leader Beverly B. Green, MD, MPH, a family doctor and researcher at Group Health, a Seattle-based nonprofit health system coordinating care and coverage. “We shifted health care from the doctor’s office to where people live: in their homes—and online,” she added.

Web-based care nearly doubled the percentage of people whose blood pressure was controlled (under 140/90 mm Hg), Dr. Green said. “And in the people with the highest blood pressure (at least 160 mm Hg systolic), who are usually hardest to treat, this Web-based care nearly tripled the proportion whose hypertension was under control.”

Eligible Group Health patients with uncontrolled hypertension and Internet access were randomly assigned to groups. One group got home monitors to track their own blood pressure—and care from pharmacists over a secure Web site. On e-mail, pharmacists helped patients set lifestyle goals and also followed standard guidelines to boost doses, switch, and combine hypertension drugs. “Secure e-mail communication made it easier for the health care team to work closely with patients to improve care,” Dr. Green said.

The comparison group got usual care. At Group Health that includes a secure Web site where patients and health teams share access to electronic medical records. “By identifying and contacting the patients in usual care, and telling them to work with their doctors to control their blood pressure, we helped get many of those patients under control,” Dr. Green said. “The Web-based care from pharmacists and regular home blood pressure monitoring helped get nearly twice as many patients under control, with average blood pressure drops of 14 points systolic and 7 points diastolic.” Next step? Seeing if Web care cut health costs.

“Patients may visit their doctors once a year, or less often,” Dr. Green said. “But their blood pressure can be out of control between visits. So patients should be involved in their care and take their own blood pressure more often, at home.” That’s just what the American Heart Association and other groups advised last month.

Around one in three U.S. adults have diagnosed hypertension, Dr. Green said. Less than half of them have their blood pressure under control, because hypertension seldom has symptoms. Blood pressure tends to rise with age and weight, so the “silent killer” is spreading as Americans grow older and heavier.

“This study is an example of good implementation science,” said Michael Lauer, MD, director of the NHLBI’s Division of Prevention and Population Sciences. “This kind of work, examining how to translate prior research discoveries into real benefits for patients, is critical to our efforts to maximize the value of the research the NIH supports.”

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Group Health Center for Health Studies

Founded in 1947, Group Health is a Seattle-based, consumer-governed, nonprofit health care system that coordinates care and coverage. For 25 years, the Group Health Center for Health Studies has conducted research on preventing, diagnosing, and treating major health problems. Government and private research grants provide its main funding.
Contact: Rebecca Hughes.(JavaScript must be enabled to view this email address)
206-287-2055
Group Health Cooperative Center for Health Studies

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